ELEVATE BRIDGEPORT

Christmas Cookie Decorating Party

Tuesday, December 16th, 2025

Student Full Name

Student's Email

Student's Phone Number

Parent/Guardian Full Name

Parent/Guardian Phone Number

Parent/Guardian Email

Emergency Contact Full Name

Emergency Contact Phone Number

What school do you attend?

What grade are you in?

Do you have any food allergies? Write N/A if none.

I give permission for my child to go with Elevate Bridgeport staff for the Christmas Cookie Decorating Party

I hereby grant Elevate Bridgeport permission to use the above student's likeness in a photograph, video, or other digital media in any and all it's publications and social media